INDIVIDUAL/JOINT ACCOUNT APPLICATION FORM - Delphi Bank

INDIVIDUAL/JOINT ACCOUNT APPLICATION FORMACCOUNT DETAILSAccount NameAccount Number (Bank use only)CUSTOMER 1 PERSONAL DETAILSTitleFull Name (1):Customer Number (Bank use only)Date of BirthResidential Address (PO box is NOT acceptable)StreetSuburbStatePostcodeTelephone Numbers HomeOfficeMobileEmail AddressUnique ID wordOccupationName of EmployerMailing Address (if different from above)SuburbStatePostcodeCountryTFNSource of fundsCUSTOMER 2 PERSONAL DETAILSTitleFull Name (1):Customer Number (Bank use only)Date of BirthResidential Address (PO box is NOT acceptable)StreetSuburbStatePostcodeCountryTelephone Numbers HomeEmail AddressOccupationMailing Address (if different from above)StreetOfficeName of EmployerMobileUnique ID wordSuburbStateCountryTFNSource of fundsPERSONAL TAX FILE NUMBER/EXEMPTIONInterest earned on an account is income and may be subject to income tax. Accounts earning interest are subject to Tax FileNumber (“TFN”) legislation. It is not compulsory for you to provide your TFN, but if you are an Australian resident and youchoose not to provide your TFN, withholding tax calculated at the highest marginal tax rate, plus the Medicare levy will bededucted form any interest earned and remitted in your name to the Australian Taxation Office.TFNQuoted / Not Quoted (circle)Version 1 Web: August 2011 Bank of Cyprus Australia Ltd ABN 51 092 167 907 AFSL/Australian Credit Licence 244611. Bank of Cyprus Australia Limited is a wholly owned subsidiary of Bendigo and Adelaide Bank Limited

INDIVIDUAL/JOINT ACCOUNT APPLICATION FORMCUSTOMER AGREEMENTI/We agree: (a) that I/we have received a copy of the relevant Terms and Conditions (Part A & B) and/or Product Disclosure Statement that apply to the account and agree to be bound by the Terms and Conditions whichapply from time to time to this account opened by me/us with the Bank; (b) that documents presented for identification purposes may be verified by the Bank with an appropriate authority; (c) that the Bank may charge thisaccount, another account controlled by me/either of us or recover from me/either of us personally any bank fees, government charges, taxes, or duties imposed on transactions that relate to my/our account; (d) to checkaccount statements and notify the bank of any errors, inconsistencies or unusual transactions within 30 days of receiving each account statement; and (e) that the Bank may be required to pass on information about me/us in compliance with the Anti-Money laundering and Counter Terrorism Financing Act 2006 (Cth) (AML Act), and that I/we will provide such information and assistance that may be requested by the Bank to comply with itsobligations under the AML Act, and I/we will indemnify the Bank against any loss caused by my/our failure to provide such assistance. I/We acknowledge and declare that I/we: (f) believe the details in this application formincluding this acknowledgement and declaration to be true and correct in every particular; (g) the names of persons nominated in this application form are authorised to operate this account (Nominated Persons) using thespecimen signatures provided in this form; (h) if any one or more of the Nominated Persons dies, then the Bank may treat the balance of the account as payable to the surviving Nominated Persons, and the Bank is freefrom liability arising from paying or delivering money to the surviving Nominated Persons; (i) the liability of the Nominated Persons is joint and several if the account becomes overdrawn; (j) the Bank may credit the accountwith any instruments payable to one or more of the Nominated Persons; and (k) for joint accounts, any instruction by either party to “Freeze” the account is considered binding and the Bank will only “unfreeze” the accountwith signed agreement from both parties or through the instruction of a court order.Privacy declarations I/We agree that: (a) the Bank may exchange information about me/us including but not limited to information provided in this application, information that I/we give to the Bank, information that theBank lawfully obtains about me/us, and transaction details and history associated with any account(s) that I/we hold with the Bank (Personal Information) with any of its related entities; (b) where the Bank has engageda service provider to perform a function on its behalf it may exchange Personal Information with that service provider; (c) the Bank might provide Personal Information to parties other than service providers or its relatedentities where required by law to do so, or otherwise with my/our consent; and (d) Personal Information may be used by the Bank, its related entities or a service provider to open the account(s), administer the account(s),and/or conduct product development and research activities. I/We understand that: (e) if I/we do not provide the information required in this application form, or do not agree to the use of Personal Information above, theBank may refuse this application; (f) I/we can request access to Personal Information held by the Bank , and if I/we wish to access my/our information or have any queries in relation to the manner in which the Bankhandles the Personal Information, I/we may view the privacy policy at www.bankofcyprus.com.au, contact 1300 660 500 to request the privacy policy from a Bank branch, or email a request to service@bankofcyprus.com.au; and (g) from time to time the Bank will provide me/us with information about its products and services. If you do not wish to receive such information, please place a cross in the boxAccount NameAccount Number (Bank use only)By signing this form you agree to abide by all terms and conditions detailed in this form.Either to signBoth to signCustomer (1) Full Name Date SignatureCustomer (2) Full Name Date SignatureBANK USE ONLYTYPE OF ACCOUNT(S) REQUIREDFACILITIES REQUIREDLibertySavingsCash ManagementMidasPassbookDeemingTerm DepositCurrencyAUDEURUSDCheque BookDeposit BookInternet BankingATM cardVisa debit cardGBPNZDJPYCHECKLIST1) Terms and Conditions parts A and B given2) Product Disclosure Statement given3) Risk assessment completed4) Original ID sighted & verified5) Residential address verified and entered on Equation.6) Legible photocopy of ID attached7) Signing instructions completed8) Customer number created (ANC)9) Account number created (OCA)10) Unique identification word entered (CIM)11) Signatures added12) Account name entered (A01)13) TFN loaded14) TFN blacked out15) Cheque book ordered (if required) (A02) (CBR)16) Deposit book ordered (A02) (CBR)17) ATM card ordered18) Visa debit card ordered19) Internet banking application completedPrepared by (CSO/RM) Name Date SignatureChecked by (CSM) Name Date SignatureVersion 1 Web: August 2011 Bank of Cyprus Australia Ltd ABN 51 092 167 907 AFSL/Australian Credit Licence 244611. Bank of Cyprus Australia Limited is a wholly owned subsidiary of Bendigo and Adelaide Bank Limited